PATENT APPUCATiON FEE DETERMINATi0^a RECORD
Effective October 1 , 2001
Application or Docket Number
CLAIMS AS FILED • PART 1
(Column 1 ) (Column 2^
TOTAL CLAIMS
FOR
TOTAL CHARGEABLE CLAIMS
INDEPENDENT CLAIMS
3£
NUMBER FILED
^ minus 20=
minus 3 =
NUMBER EXTRA
MULTIPLE DEPENDENT CLAIM PRESENT
□
' If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
(Column 1)
(Column 2)
(Column 3)
1
2
lU
CLAIMS
REMAINING
AFTER
AMENPiy^NT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
S
O
z
Total
Minus
-HI
Ui
Independent
Minus
~ II
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Ck)lumn 3^
CD
Z
Ui
i - 5 -
CLAIMS
REMAINING
AFTER
AMENDMENT
t If '
t - *
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
o
z
Total
*
Minus
Ui
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENt CLAIM
□
7 y y •:
y > V- n ^'
i'P^i ..It.;
(Column 1)
Total
Independent
CLAIMS
REMAINING
AFTER
AMENDMENT
(Column 2) (Column 3)
Minus
Minus
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
SMALL ErttiTY
TYPE
OTHER THAN
OR SMALL ENTITY
tf the entry in column 1 is less thsn the entry In column 2. wrBe *0' in coli^n 3.
* If ihe "Highest Number Previously Paid For' IN THIS SPACE is less than 20. enter •20/
•*H the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3."
The 'Highest Number Previously Paid For* (Total or Independent) is the highest number found in the appropriate box in column 1 .
RATE
FEE
RATE
FEE
BASIC FEE
: 370.00
OH
BASIC FEE
740.00
X$9=
OR
X$18=
X7D'
X42=
OR
X84=
4140-
OR
+280=
TOTAL
OR
TOTAL
OTHER THAN
SMALL ENTITY
OR
SMALL ENTITY
ADDI-
ADDI-
RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$9=
On
X$18=
X42=
un
+140=.
OR
+280=
TOTAL
AOOIT FEE
OR
TOTAL
ADOtT FEE
ADDI-
ADDI-
RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+ 140=
OR
+280=
TOTAL!
AOpiTFEEl
TOTAL
ADDI-
ADDI-
RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$ 9=
OR
X$18=
X423
OR
X84=
+140=
OR
+280=
TOTAL
AOOn-. FEE
OR ^^"^^
ADDIT FEE
F0RMPT0475 (Rev. 8/D1)
Patent and Trademark Offtw, U.S. DEPARTMENT OF COMMERCE